EP1833564B1 - System for temporary programming for implanted medical devices - Google Patents
System for temporary programming for implanted medical devices Download PDFInfo
- Publication number
- EP1833564B1 EP1833564B1 EP05809800.5A EP05809800A EP1833564B1 EP 1833564 B1 EP1833564 B1 EP 1833564B1 EP 05809800 A EP05809800 A EP 05809800A EP 1833564 B1 EP1833564 B1 EP 1833564B1
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- European Patent Office
- Prior art keywords
- operation instructions
- patient
- medical device
- therapy
- repeater
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
- A61N1/37252—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
- A61N1/37264—Changing the program; Upgrading firmware
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
- A61N1/37252—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
- G16H40/63—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for local operation
Definitions
- the present invention generally relates to implanted medical devices and external repeaters. More specifically, the present invention relates to devices for temporary programming of implanted medical devices.
- IMDs implanted medical devices
- Such implanted medical devices may provide rhythm altering electrical impulses to a patient's heart or other types and forms of electrical or neuro-muscular stimulus.
- IMDs may also infuse a variety of therapeutic agents.
- Many of these IMDs are implanted beneath the skin of a patient and frequent physical access to the devices for alteration of the intensity, duration or other characteristics of the therapy is not desirable.
- US 4,253,466 relates to a temporary and permanent programmable digital cardiac pacemaker comprising a programmer, a programming head and a pulse generator. Many of the programmable functions of the pulse generator can either be programmed on a permanent or a temporary basis. The temporary program may be terminated by a corresponding signal sent to the pacemaker or by removing the programming head.
- Operation of an IMD based on a set of proposed or temporary operating parameters is also currently known.
- the current technology requires that a patient be physically present at a caregiver's location and within local telemetry range of the caregiver's programming equipment.
- the caregiver's programming equipment is required to instruct the IMD to adopt the temporary parameters as normal operating parameters.
- Current IMD only permit operation in a temporary parameter mode when the IMD is proximate to and in continuous communication with the caregiver's programming equipment.
- US 5 720 770 shows a system for programming an implanted medical device according to the preamble of claim 1.
- the present invention relates to a system for programming an implanted medical device as defined in claim 1.
- Preferred embodiments are defined by the dependent claims.
- FIG. 1 shows a patient 10 within whose body 12 is implanted an implantable medical device 14 (shown as a cardiac rhythm management device) to provide therapy to the patient.
- the device includes communication circuitry to permit wireless communication with an external repeater 16.
- Repeater 16 may provide operating instructions to device 14 and may receive data from device 14 regarding therapy provided by device 14.
- Repeater 16 may also collect data from device 14 regarding the reaction of patient 10 to the therapy being provided by device 14.
- a caregiver facility 18 Caregivers at facility 18 may provide instructions to and receive information from repeater 16. While a caregiver at such a facility is preferably a physician who is treating patient 10 and familiar with the health situation of patient 10, the caregiver may also be a specialist in the particular device implanted in patient 10 who is working in conjunction with the patient's physician. It is anticipated that device 14 could include devices providing electrical impulses to some portion of a patient's body (such as defibrillators or pacemakers) or may deliver therapeutic agents (such as infusion pumps). While the actions performed by the device may differ depending on the application and medical condition being treated, the functions and features described below for altering therapy instructions or parameters are applicable to any similar implanted medical devices (IMDs).
- the caregiver may be using a programming device at the facility to develop and store instructions to be uploaded to repeater 16 for transmission to device 14. The programming device may also receive information from device 14 through repeater 16 to permit the caregiver to review and analyze the patient's response to therapy.
- the programming device may be integral with the repeater.
- device 14 includes a communication subsystem 20 and a therapy delivery subsystem 22.
- Therapy delivery subsystem 22 via a conduit 28 to the portion of patient 10's body 12 where therapy is desired.
- conduit 28 is an electrical lead connecting device 14 (a pacemaker) to the patient's heart.
- Therapy delivery subsystem 22 may also include a patient status sensing capability which allows device 14 to sense and record particular elements of patient 10's condition which might be affected by the therapy delivered by device 14.
- subsystem 22 of the pacemaker of FIG. 1 may collect and record data on heart rhythm which may be used to determine if different therapy protocols may be desirable for patient 10.
- subsystem 22 may collect and record blood sugar levels.
- Device 14 also may include an on-board memory 24 for storing and maintaining normal programming, such as operating instructions and parameters, on which the normal therapy provided to the patient is based.
- Normal memory 24 may also referred to as permanent memory, although, as will be discussed below, memory 24 may be subject to being overwritten with new instructions and parameters of operation to alter the therapy provided to patient 10 by device 14.
- Device 14 may also include a temporary on-board memory 26 for storing and maintaining new or temporary programming, such as operating instructions and parameters, for delivering therapy to patient 10.
- a switch 30 which is able to toggle operation of device 14 between the two different sets of operating instructions and parameters that may be stored in memories 24 and 26.
- Switch 30 may be a virtual or software switch which is operable based on instructions received by device 14 through repeater 16, or based on programming within device 14.
- switch 30 may also include a physical magnetic switch actuated by patient 10, or the caregiver or another person adjacent patient 10 using a magnetic wand.
- uploading and testing of new operating instructions to device 14 includes a number of guards to prevent detrimental effects to patient 10 caused by alterations of the programming of device 10. While it is known to have a patient schedule an office visit with their caregiver to change or adjust the programming of the instructions used by an implanted medical device, such as device 10, such office visits are sometimes not possible or may be impractical or inconvenient. Remote programming of medical devices is also known as possible, but has not been a viable approach due to a lack of appropriate and necessary safeguards to protect against mistakes in reprogramming and/or new programming which does not have the desired effect on the patient's health.
- the procedures laid out in FIGS. 3A and 3B illustrates one embodiment of remote programming of IMDs including adequate patient safeguards to permit secure and safe programming alterations.
- patient 10 is in close proximity with repeater 16 so that repeater 16 may transmit signals to and receive signals from the IMD or device 14.
- Device 14 is delivering therapy to patient 10 based on a set of normal programming of instructions stored in memory 24 on-board device 14.
- the caregiver is located remotely from patient 10 and repeater 16 and establishes communication with the repeater and patient 10 to begin the loading and testing of new programming for device 14.
- Remotely located is defined to mean the caregiver and the patient (along with the IMD and the repeater) are not located at the same physical location.
- the caregiver may be a physician at a hospital and the patient may be located at his or her home.
- a patient (along with the IMD and the repeater) and caregiver located in the same room or treatment bay are not considered to be remotely located with respect to each other.
- the caregiver then uploads new programming to repeater 16 for communication to device 14 at 102.
- the new programming is then transferred from repeater 16 to device 14, which in turn stores the new programming in memory 26 on-board device 14 for temporary storage at 103.
- the caregiver instructs device 14 to begin delivering therapy to patient 10 based on the new programming for a first test period at 104.
- the first test period is relatively short (preferably ranging from a few seconds to a few minutes) to determine if there are any immediate ill effects to the health of patient 10.
- the first test period at a minimum must extend long enough to verify that the new programming has been fully and correctly uploaded to memory 26.
- the first test period also may extend long enough to collect data regarding certain parameters of heart function and patient reaction to the new programming.
- the first test period may further extend to permit a caregiver to access the data regarding the certain parameters of heart function and patient reaction to the new programming via remote communication between repeater 16 and caregiver facility 18, so that the caregiver can verify that the new programming is initially functioning adequately.
- patient 10 may remain within the immediate vicinity of repeater 16 so that repeater 16 is receiving a generally continuous stream of data regarding patient 10's reaction to the new therapy regime.
- the nature of the communication stream may be periodic, with polling and response required at certain regular intervals, and still be continuous communication as referred to herein.
- Such a continuous, periodic stream of communication enables device 14 to conserve battery life during the process.
- device 14 is configured at this stage to automatically revert to the prior normal programming if patient 10 moves away from the immediate vicinity of repeater 16. Thus, if patient 10 has a strong negative reaction to the new programming and collapses or falls away from repeater 16, device 14 will discontinue use of the new programming.
- patient 10 As a safety measure, it is desirable that patient 10 remain near repeater 16 for the first test period so that data regarding the function of device 14 in response to the new programming can be verified. If patient 10 moves away from repeater 16 prior to completion of this first test period, device 14 will revert to the normal programming, even if no ill effects of the new programming have been detected.
- the patient may be given an opportunity to critique the new programming of device 14 and the effect that therapy based on this new programming may have had upon the patient's perceived health and quality of life, at 108. If the patient's perception is that the therapy delivered by device 14 degrades comfort, interferes with the patient's normal daily activities, or otherwise has a deleterious impact on the patient, at 116, device 14 may be instructed to revert to providing therapy based on the normal programming held by memory 24.
- the caregiver may review the function of device 14 at 108 to determine if the new programming results in the desired function of device 14 and the desired response to the new therapy is detected in patient 10.
- the caregiver may also, at 116, direct device 14 to revert back to providing therapy based on the normal programming within memory 24.
- the instruction to device 14 to revert to therapy based on the normal programming is communicated through repeater 16 by the caregiver in consultation with patient 10.
- repeater 16 may include a button, switch or other feature permitting patient 10 to provide the instruction to device 14 to revert to normal programming within memory 24.
- device 14 can be instructed to operate for a second test period, at 112.
- patient 10 and device 14 would not necessarily need to remain directly adjacent to repeater 16, as required during the first test period.
- patient 10 may be ambulatory and would only need to periodically return to the proximity of repeater 16 so that repeater 16 can download information from device 14 to monitor function of device 14.
- Patient 10 may need to have the repeater 16 query device 14 one or several times a day. Repeater 16 may then communicate the status information from device 14 and possibly from patient 10 regarding function of device 14 back to the caregiver.
- Device 14 may include a function which records when the periodic transfer of information from device 14 to repeater 16 occurs. If too great of a time gap exists since the last transfer, device 14 may be programmed to automatically revert to delivering therapy based on the normal programming in memory 24, at 118. The limit on the acceptable time gap prior to reversion to therapy delivery based on normal programming may be varied to meet the particular needs and circumstances of the patient.
- the operation of device 14 delivering therapy based on the new programming is allowed to continue for the duration of the second test period, at 120.
- patient 10 is again queried as the effectiveness and desirability of therapy based on the new programming.
- the patient may request that device 14 be instructed by repeater 16 to revert to therapy delivery based on the normal programming.
- device 14 may be recording data regarding the health parameters of patient 10 which indicate the current or future health of the patient may be adversely affected, as compared to desirable or acceptable health parameters programmed into device 14.
- device 14 may be programmed to automatically revert to delivering therapy based on the normal programming, at 132.
- repeater 16 may provide the analysis tools required to verify if the parameters sensed by device 14 are within pre-programmed acceptable parameters. If the parameters are determined by repeater 16 to be outside of an acceptable range, device 14 may be programmed to revert automatically to delivering therapy based on the normal programming, at 132.
- the caregiver may also determine that the therapy delivered based on the new programming is acceptable or unacceptable, at 128.
- the caregiver may communicate instructions to device 14 through repeater 16 to revert to delivering therapy based on the normal programming in memory 24.
- repeater 16 may include a button, switch or other feature permitting patient 10 to provide the instruction to device 14 to revert to normal programming within memory 24.
- patient 10 may be provided with a separate device, such as a hand-held device, to revert IMD to function according to the normal programming within memory 24.
- device 14 may be instructed to write the new programming into memory 24, over-writing the existing normal programming. Once written into memory 24, the new programming can be relabeled the normal programming, and device 14 can deliver therapy based on the programming newly written in memory 24 without additional contact with repeater 16 being required.
- FIGS. 4A and 4B illustrate the uploading and testing of the delivery of therapy by device 14 based on new programming.
- the process of FIGS. 4A and 4B is similar to the process detailed above, with regard to FIGS. 3A and 3B , with device 14 including a patient actuable switch 30 for reverting device 14 to therapy delivery based on the normal programming.
- patient 10 may, at 136, deliver instructions to device 14 directly to revert to therapy based on the normal programming. Patient 10 need not involve the caregiver in the reversion. Instructions to device 14 from patient 10 may be delivered by actuation of switch 30.
- the patient may also take the initiative to revert device 14 to delivering therapy based on the normal programming, at 126 and 138.
- Patient 10 may still report acceptable or non-acceptable function of device 14 at 122 and the caregiver may send instructions to revert device 14 to delivering therapy based on the normal programming.
- patient 10 may still have the ability to revert device 14 to normal programming, at 138.
- Instructions to device 14 from patient 10 may be delivered by actuation of switch 30.
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Description
- The present invention generally relates to implanted medical devices and external repeaters. More specifically, the present invention relates to devices for temporary programming of implanted medical devices.
- Current medical technology utilizes a number of implanted medical devices to provide a wide-range of therapy for patients. Such implanted medical devices (IMDs) may provide rhythm altering electrical impulses to a patient's heart or other types and forms of electrical or neuro-muscular stimulus. These IMDs may also infuse a variety of therapeutic agents. Many of these IMDs are implanted beneath the skin of a patient and frequent physical access to the devices for alteration of the intensity, duration or other characteristics of the therapy is not desirable.
- Current technology in the medical device industry allows for monitoring and communication with an implanted medical device without needing to directly access the IMD. Such access may even be accomplished remotely with telemetry tools capable of transmitting and receiving information via existing long-distance communication avenues, such as telephone, cellular communications or radio links. While these known techniques do permit remote alteration of the therapy delivered by an IMD, additional safety measures to guard against mistakes in the programming of the new therapy or unexpected consequences of application of the new therapy are desirable.
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US 4,253,466 relates to a temporary and permanent programmable digital cardiac pacemaker comprising a programmer, a programming head and a pulse generator. Many of the programmable functions of the pulse generator can either be programmed on a permanent or a temporary basis. The temporary program may be terminated by a corresponding signal sent to the pacemaker or by removing the programming head. - Operation of an IMD based on a set of proposed or temporary operating parameters is also currently known. However, the current technology requires that a patient be physically present at a caregiver's location and within local telemetry range of the caregiver's programming equipment. In addition, once proper loading of the temporary parameters into the IMD has been verified, and IMD operation based on the temporary parameters has been verified, the caregiver's programming equipment is required to instruct the IMD to adopt the temporary parameters as normal operating parameters. Current IMD only permit operation in a temporary parameter mode when the IMD is proximate to and in continuous communication with the caregiver's programming equipment.
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US 5 720 770 shows a system for programming an implanted medical device according to the preamble of claim 1. - The present invention relates to a system for programming an implanted medical device as defined in claim 1. Preferred embodiments are defined by the dependent claims.
- Aspects, embodiments or examples of the present disclosure which do not fall under the appended claims do not form part of the invention.
- The accompanying drawings, which are incorporated in and constitute a part of the description, illustrate several aspects of the invention and together with the detailed description, serve to explain the principles of the invention. A brief description of the drawings is as follows:
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FIG. 1 is a schematic view of an implantable medical device implanted within a patient's body, a repeater in proximity of the body to communicate with the device and a physician at a caregiver facility located remotely from the device and the repeater communicating with the repeater. -
FIG. 2 is a schematic view of the implantable medical device ofFIG. 1 . -
FIGS. 3A and3B are a flow chart of a process for programming the implantable medical device ofFIG. 2 with temporary operating instructions. -
FIGS. 4A and4B are a flow chart of an alternative process for programming the implantable medical device ofFIG. 2 with temporary operating instructions. - Reference will now be made in detail to exemplary aspects of the present invention which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.
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FIG. 1 shows apatient 10 within whose body 12 is implanted an implantable medical device 14 (shown as a cardiac rhythm management device) to provide therapy to the patient. The device includes communication circuitry to permit wireless communication with anexternal repeater 16.Repeater 16 may provide operating instructions todevice 14 and may receive data fromdevice 14 regarding therapy provided bydevice 14.Repeater 16 may also collect data fromdevice 14 regarding the reaction ofpatient 10 to the therapy being provided bydevice 14. - Also shown in
FIG. 1 is acaregiver facility 18. Caregivers atfacility 18 may provide instructions to and receive information fromrepeater 16. While a caregiver at such a facility is preferably a physician who is treatingpatient 10 and familiar with the health situation ofpatient 10, the caregiver may also be a specialist in the particular device implanted inpatient 10 who is working in conjunction with the patient's physician. It is anticipated thatdevice 14 could include devices providing electrical impulses to some portion of a patient's body (such as defibrillators or pacemakers) or may deliver therapeutic agents (such as infusion pumps). While the actions performed by the device may differ depending on the application and medical condition being treated, the functions and features described below for altering therapy instructions or parameters are applicable to any similar implanted medical devices (IMDs). The caregiver may be using a programming device at the facility to develop and store instructions to be uploaded to repeater 16 for transmission todevice 14. The programming device may also receive information fromdevice 14 throughrepeater 16 to permit the caregiver to review and analyze the patient's response to therapy. - If the caregiver and
patient 10 are both located atcaregiver facility 18, the programming device may be integral with the repeater. - Referring now to
FIG. 2 ,device 14 includes acommunication subsystem 20 and atherapy delivery subsystem 22.Therapy delivery subsystem 22 via aconduit 28 to the portion ofpatient 10's body 12 where therapy is desired. In the example shown above inFIG. 1 ,conduit 28 is an electrical lead connecting device 14 (a pacemaker) to the patient's heart.Therapy delivery subsystem 22 may also include a patient status sensing capability which allowsdevice 14 to sense and record particular elements ofpatient 10's condition which might be affected by the therapy delivered bydevice 14. For example,subsystem 22 of the pacemaker ofFIG. 1 may collect and record data on heart rhythm which may be used to determine if different therapy protocols may be desirable forpatient 10. In another example, ifdevice 14 were an infusion pump for delivering insulin,subsystem 22 may collect and record blood sugar levels. -
Device 14 also may include an on-board memory 24 for storing and maintaining normal programming, such as operating instructions and parameters, on which the normal therapy provided to the patient is based.Normal memory 24 may also referred to as permanent memory, although, as will be discussed below,memory 24 may be subject to being overwritten with new instructions and parameters of operation to alter the therapy provided topatient 10 bydevice 14.Device 14 may also include a temporary on-board memory 26 for storing and maintaining new or temporary programming, such as operating instructions and parameters, for delivering therapy topatient 10. Withindevice 14 may be aswitch 30 which is able to toggle operation ofdevice 14 between the two different sets of operating instructions and parameters that may be stored inmemories device 14 throughrepeater 16, or based on programming withindevice 14. Alternatively,switch 30 may also include a physical magnetic switch actuated bypatient 10, or the caregiver or another personadjacent patient 10 using a magnetic wand. - Referring now to
FIGS. 3A and3B , uploading and testing of new operating instructions todevice 14 includes a number of guards to prevent detrimental effects topatient 10 caused by alterations of the programming ofdevice 10. While it is known to have a patient schedule an office visit with their caregiver to change or adjust the programming of the instructions used by an implanted medical device, such asdevice 10, such office visits are sometimes not possible or may be impractical or inconvenient. Remote programming of medical devices is also known as possible, but has not been a viable approach due to a lack of appropriate and necessary safeguards to protect against mistakes in reprogramming and/or new programming which does not have the desired effect on the patient's health. The procedures laid out inFIGS. 3A and3B illustrates one embodiment of remote programming of IMDs including adequate patient safeguards to permit secure and safe programming alterations. - To initiate the installation and testing of new programming for an IMD,
patient 10 is in close proximity withrepeater 16 so thatrepeater 16 may transmit signals to and receive signals from the IMD ordevice 14.Device 14 is delivering therapy topatient 10 based on a set of normal programming of instructions stored inmemory 24 on-board device 14. At 100, the caregiver is located remotely frompatient 10 andrepeater 16 and establishes communication with the repeater andpatient 10 to begin the loading and testing of new programming fordevice 14. "Remotely located" is defined to mean the caregiver and the patient (along with the IMD and the repeater) are not located at the same physical location. For example, the caregiver may be a physician at a hospital and the patient may be located at his or her home. On the other end of the spectrum, a patient (along with the IMD and the repeater) and caregiver located in the same room or treatment bay are not considered to be remotely located with respect to each other. The caregiver then uploads new programming torepeater 16 for communication todevice 14 at 102. The new programming is then transferred fromrepeater 16 todevice 14, which in turn stores the new programming inmemory 26 on-board device 14 for temporary storage at 103. - Once the new programming has been uploaded from
repeater 16 todevice 14 and stored inmemory 26, the caregiver, throughrepeater 16, instructsdevice 14 to begin delivering therapy topatient 10 based on the new programming for a first test period at 104. The first test period is relatively short (preferably ranging from a few seconds to a few minutes) to determine if there are any immediate ill effects to the health ofpatient 10. The first test period, at a minimum must extend long enough to verify that the new programming has been fully and correctly uploaded tomemory 26. The first test period also may extend long enough to collect data regarding certain parameters of heart function and patient reaction to the new programming. The first test period may further extend to permit a caregiver to access the data regarding the certain parameters of heart function and patient reaction to the new programming via remote communication betweenrepeater 16 andcaregiver facility 18, so that the caregiver can verify that the new programming is initially functioning adequately. - During this first test period, at 106,
patient 10 may remain within the immediate vicinity ofrepeater 16 so thatrepeater 16 is receiving a generally continuous stream ofdata regarding patient 10's reaction to the new therapy regime. The nature of the communication stream may be periodic, with polling and response required at certain regular intervals, and still be continuous communication as referred to herein. Such a continuous, periodic stream of communication enablesdevice 14 to conserve battery life during the process. At 118,device 14 is configured at this stage to automatically revert to the prior normal programming ifpatient 10 moves away from the immediate vicinity ofrepeater 16. Thus, ifpatient 10 has a strong negative reaction to the new programming and collapses or falls away fromrepeater 16,device 14 will discontinue use of the new programming. As a safety measure, it is desirable thatpatient 10 remain nearrepeater 16 for the first test period so that data regarding the function ofdevice 14 in response to the new programming can be verified. Ifpatient 10 moves away fromrepeater 16 prior to completion of this first test period,device 14 will revert to the normal programming, even if no ill effects of the new programming have been detected. - During the first test period and once the first test period has been completed, the patient may be given an opportunity to critique the new programming of
device 14 and the effect that therapy based on this new programming may have had upon the patient's perceived health and quality of life, at 108. If the patient's perception is that the therapy delivered bydevice 14 degrades comfort, interferes with the patient's normal daily activities, or otherwise has a deleterious impact on the patient, at 116,device 14 may be instructed to revert to providing therapy based on the normal programming held bymemory 24. At 110, during the first test period and upon completion of the first test period, the caregiver may review the function ofdevice 14 at 108 to determine if the new programming results in the desired function ofdevice 14 and the desired response to the new therapy is detected inpatient 10. If the caregiver determines that the level of function ofdevice 14 is not having the desired results with regard to the patient's health, the caregiver may also, at 116,direct device 14 to revert back to providing therapy based on the normal programming withinmemory 24. At 116, the instruction todevice 14 to revert to therapy based on the normal programming is communicated throughrepeater 16 by the caregiver in consultation withpatient 10. Alternatively,repeater 16 may include a button, switch or otherfeature permitting patient 10 to provide the instruction todevice 14 to revert to normal programming withinmemory 24. - The uploading of new programming and temporary operation of
device 14 during the first test period have been described as remote fromcaregiver location 18. It is anticipated that the uploading new programming and the first test period could also occur atcaregiver location 18. - If the patient and caregiver concur that the function of
device 14 and the patient's response to the function of device based on the new programming are adequate and desirable,device 14 can be instructed to operate for a second test period, at 112. During this second test period,patient 10 anddevice 14 would not necessarily need to remain directly adjacent torepeater 16, as required during the first test period. During the second test period,patient 10 may be ambulatory and would only need to periodically return to the proximity ofrepeater 16 so thatrepeater 16 can download information fromdevice 14 to monitor function ofdevice 14.Patient 10 may need to have therepeater 16query device 14 one or several times a day.Repeater 16 may then communicate the status information fromdevice 14 and possibly frompatient 10 regarding function ofdevice 14 back to the caregiver.Device 14 may include a function which records when the periodic transfer of information fromdevice 14 torepeater 16 occurs. If too great of a time gap exists since the last transfer,device 14 may be programmed to automatically revert to delivering therapy based on the normal programming inmemory 24, at 118. The limit on the acceptable time gap prior to reversion to therapy delivery based on normal programming may be varied to meet the particular needs and circumstances of the patient. - Provided that
repeater 16 anddevice 14 remain in periodic communication, the operation ofdevice 14 delivering therapy based on the new programming is allowed to continue for the duration of the second test period, at 120. Upon completion of the second test period, at 122,patient 10 is again queried as the effectiveness and desirability of therapy based on the new programming. At this point or at any time during the second test period, if the patient finds the therapy produces undesirable results, the patient may request thatdevice 14 be instructed byrepeater 16 to revert to therapy delivery based on the normal programming. At 124,device 14 may be recording data regarding the health parameters ofpatient 10 which indicate the current or future health of the patient may be adversely affected, as compared to desirable or acceptable health parameters programmed intodevice 14. If such adverse effects are sensed and/or recorded bydevice 14,device 14 may be programmed to automatically revert to delivering therapy based on the normal programming, at 132. Alternatively,repeater 16 may provide the analysis tools required to verify if the parameters sensed bydevice 14 are within pre-programmed acceptable parameters. If the parameters are determined byrepeater 16 to be outside of an acceptable range,device 14 may be programmed to revert automatically to delivering therapy based on the normal programming, at 132. - At the completion of the second test period, or at any time during the second test period, the caregiver may also determine that the therapy delivered based on the new programming is acceptable or unacceptable, at 128. At the completion of the second test period or at any time during the second test period, if the caregiver decides that the therapy based on the new programming is not acceptable, at 134, the caregiver may communicate instructions to
device 14 throughrepeater 16 to revert to delivering therapy based on the normal programming inmemory 24. Alternatively,repeater 16 may include a button, switch or otherfeature permitting patient 10 to provide the instruction todevice 14 to revert to normal programming withinmemory 24. Alternatively,patient 10 may be provided with a separate device, such as a hand-held device, to revert IMD to function according to the normal programming withinmemory 24. - If the caregiver determines the new programming and the therapy delivered based on the new programming are acceptable, at 130,
device 14 may be instructed to write the new programming intomemory 24, over-writing the existing normal programming. Once written intomemory 24, the new programming can be relabeled the normal programming, anddevice 14 can deliver therapy based on the programming newly written inmemory 24 without additional contact withrepeater 16 being required. -
FIGS. 4A and4B illustrate the uploading and testing of the delivery of therapy bydevice 14 based on new programming. The process ofFIGS. 4A and4B is similar to the process detailed above, with regard toFIGS. 3A and3B , withdevice 14 including a patient actuable switch 30 for revertingdevice 14 to therapy delivery based on the normal programming. At 108, ifpatient 10 determines that the therapy delivery based on the new programming is not acceptable, patient 10 may, at 136, deliver instructions todevice 14 directly to revert to therapy based on the normal programming.Patient 10 need not involve the caregiver in the reversion. Instructions todevice 14 frompatient 10 may be delivered by actuation ofswitch 30. - In
FIG. 4B , during and following the second test period, the patient may also take the initiative to revertdevice 14 to delivering therapy based on the normal programming, at 126 and 138.Patient 10 may still report acceptable or non-acceptable function ofdevice 14 at 122 and the caregiver may send instructions to revertdevice 14 to delivering therapy based on the normal programming. However,patient 10 may still have the ability to revertdevice 14 to normal programming, at 138. Instructions todevice 14 frompatient 10 may be delivered by actuation ofswitch 30. - Having described preferred aspects and embodiments of the present invention, modifications and equivalents of the disclosed concepts may readily occur to one skilled in the art. However, it is intended that such modifications and equivalents be included within the scope of the claims which are appended hereto.
Claims (20)
- A system for programming an implanted medical device comprising:a medical device (14) configured to be implanted within in a body (12) of a patient; the medical device (14) including electrical circuitry to provide treatment to the patient; a first digital storage area (24) for holding normal operation instructions and settings, a second digital storage area (26) for holding temporary operating instructions andsettings, a communications subsystem (20) and a timing subsystem (22);a repeater (16) external of the patient's body, the repeater including a communication subsystem (20) configured to communicate with the communications subsystem of the medical device and with a programming device;the medical device and the repeater remotely located from the programming device;the medical device (14) configured to provide therapy to the patient using the normal operation instructions and settings stored in the first digital storage area;characterized in thatthe repeater (16) is configured to transmit temporary operation instructions andsettings to the medical device (14) for storage in the second digital storage area (26);the repeater (16) is configured to instruct the medical device (14) to use the temporary operating instructions and settings to deliver therapy to the patient;wherein after the medical device (14) has begun delivering therapy using the temporary operation instructions and settings, the medical device (14) is reverted to the normal operation instructions and settings if the medical device fails to receive a generally continuous continuation signal from the repeater (16) during a first predetermined period of time, wherein the generally continuous continuation signal includes poll and response communications, wherein the medical device (14) is configured to revert to delivery of therapy to the patient based on the normal operation instructions if the medical device (14) does not receive a periodic continuation signal from the repeater (16) during a second predetermined period of time, wherein the repeater (16) is configured to query the medical device (14) one or several times a day during the second period of time to avoid reverting to delivery of therapy to the patient based on the normal operation instructions.
- The system of claim 1, wherein the communication subsystem (20) of the medical device (14) is configured to receive the periodic continuation signal from the repeater and the medical device (14) is configured to
not revert to the normal operation instructions when the patient is ambulatory during the second predetermined period of time. - The system of claim 1, wherein the medical device (14) is configured to replace the normal operation instructions with the temporary operation instructions and normally deliver therapy to the patient based on the formerly temporary operation instructions after the second predetermined period of time.
- The system of claim 1, wherein the medical device (14) is configured to revert to delivery of therapy to the patient based on the normal operation instructions after the second predetermined period of time, unless instructed to replace the normal operation instructions with the temporary operation instructions and normally deliver therapy to the patient based on the formerly temporary operation instructions.
- The system of claim 1, wherein the repeater (16) is configured to signal the medical device to replace the normal instructions with the temporary operation instructions and normally deliver therapy to the patient based on the formerly temporary operation instructions.
- The system of claim 1, wherein the repeater (16) is configured to signal to the medical device to revert to delivery of therapy to the patient based on the normal operation instructions, and remove the temporary operation instructions from the second digital storage area.
- The system of claim 1, wherein the medical device (14) is configured to sense patient response to the therapy based on the temporary operation instructions and revert to delivery of therapy based on the normal operation instructions if the medical device senses an adverse response to the therapy based on the temporary operation instructions.
- The system of claim 1, wherein the medical device (14) is configured to sense patient response to the therapy based on the temporary operation instructions and, if the response is acceptable, to replace the normal instructions with the temporary operation instructions and normally deliver therapy to the patient based on the formerly temporary operation instructions.
- The system of claim 1, wherein the repeater (16) is configured to receive data from the medical device regarding patient response to therapy delivered based on the temporary operation instructions and communicating to the medical device (14) to revert to delivering therapy based on the normal operation instructions if the patient response to therapy based on the temporary operation instructions is adverse.
- The system of claim 1, wherein the repeater (16) is configured to receive data from the medical device (14) regarding patient response to therapy delivered based on the temporary operation instructions and, if the response is acceptable, to signal the medical device (14) to replace the normal instructions with the temporary operation instructions and normally deliver therapy to the patient based on the formerly temporary operation instructions.
- The system of claim 1, wherein the device (14) is configured to respond to the patient signaling the device by reverting to delivery of therapy based on the normal operation instructions if the temporary operation instructions do not provide acceptable patient response.
- The system of claim 11, wherein the patient signals the medical device (14) to revert to delivering therapy based on the normal operation instructions using a magnet.
- The system of claim 11, wherein the patient signals the medical device (14) to revert to delivering therapy based on the normal operation instructions using an electronic wand.
- The system of claim 1, wherein the medical device (14) is configured to respond to the patient signaling the medical device (14) by replacing the normal operation instructions with the temporary operation instructions and normally delivering therapy to the patient based on the formerly temporary operation instructions.
- The system of claim 14, wherein the patient signals the medical device (14) to replace the normal instructions with the temporary operation instructions and normally deliver therapy to the patient based on the formerly temporary operation instructions using a magnet.
- The system of claim 14, wherein the patient signals the medical device (14) to replace the normal instructions with the temporary operation instructions and normally deliver therapy to the patient based on the formerly temporary operation instructions using an electronic wand.
- The system of claim 1, wherein the medical device (14) is configured to respond to a caregiver signaling the device by reverting to delivering therapy based on the normal operation instructions if the temporary operation instructions do not provide acceptable patient response.
- The system of claim 17, wherein the caregiver signals the medical device (14) to revert to delivering therapy based on the normal operation instructions using a magnet.
- The system of claim 17, wherein the caregiver signals the medical device (14) to revert to delivering therapy based on the normal operation instructions using an electronic wand.
- The system of claim 1 wherein the first predetermined period of time ranges from a few seconds to a few minutes.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/993,699 US7460912B2 (en) | 2004-11-19 | 2004-11-19 | System and method for temporary programming for implanted medical devices |
PCT/US2005/036811 WO2006055131A1 (en) | 2004-11-19 | 2005-10-14 | System and method for temporary programming for implanted medical devices |
Publications (2)
Publication Number | Publication Date |
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EP1833564A1 EP1833564A1 (en) | 2007-09-19 |
EP1833564B1 true EP1833564B1 (en) | 2017-01-11 |
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EP05809800.5A Not-in-force EP1833564B1 (en) | 2004-11-19 | 2005-10-14 | System for temporary programming for implanted medical devices |
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US (2) | US7460912B2 (en) |
EP (1) | EP1833564B1 (en) |
JP (1) | JP4940147B2 (en) |
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US7460912B2 (en) * | 2004-11-19 | 2008-12-02 | Cardiac Pacemakers, Inc. | System and method for temporary programming for implanted medical devices |
US20080082144A1 (en) * | 2006-09-29 | 2008-04-03 | James Marcotte | Universal usb-based telemetry rf head |
DE102007037947A1 (en) * | 2007-08-11 | 2009-02-12 | Biotronik Crm Patent Ag | Remote programmable personal device and arrangement and method for remote programming of a personal device |
DE102007037948A1 (en) * | 2007-08-11 | 2009-02-12 | Biotronik Crm Patent Ag | Method for the safe reprogramming of clinically relevant parameters in the context of the remote programming of an electronic implant |
US9848058B2 (en) | 2007-08-31 | 2017-12-19 | Cardiac Pacemakers, Inc. | Medical data transport over wireless life critical network employing dynamic communication link mapping |
US8395498B2 (en) | 2007-08-31 | 2013-03-12 | Cardiac Pacemakers, Inc. | Wireless patient communicator employing security information management |
US8121689B2 (en) * | 2007-10-01 | 2012-02-21 | Cardiac Pacemakers, Inc. | Proactive interactive limits override for implantable medical device user interface |
US8798755B2 (en) | 2008-10-03 | 2014-08-05 | Duke University | Non-regular electrical stimulation patterns for treating neurological disorders |
US8923981B2 (en) | 2008-10-03 | 2014-12-30 | Duke University | Non-regular electrical stimulation patterns designed with a cost function for treating neurological disorders |
CN102238978B (en) | 2008-10-03 | 2014-09-24 | 杜克大学 | Non-regular electrical stimulation patterns for treating neurological disorders |
US9802046B2 (en) | 2008-10-03 | 2017-10-31 | Duke University | Non-regular electrical stimulation patterns for improved efficiency in treating Parkinson's Disease |
US11013924B2 (en) | 2008-10-03 | 2021-05-25 | Duke University | Non-regular electrical stimulation patterns for treating neurological disorders |
US8812841B2 (en) | 2009-03-04 | 2014-08-19 | Cardiac Pacemakers, Inc. | Communications hub for use in life critical network |
US8319631B2 (en) | 2009-03-04 | 2012-11-27 | Cardiac Pacemakers, Inc. | Modular patient portable communicator for use in life critical network |
US9008788B2 (en) * | 2010-02-10 | 2015-04-14 | Medtronic, Inc. | Enablement and/or disablement of an exposure mode of an implantable medical device |
JP5847167B2 (en) | 2010-05-27 | 2016-01-20 | エヌディーアイ メディカル, エルエルシー | Waveform shapes for neurological disorder treatment optimized for energy efficiency |
WO2012092197A2 (en) * | 2010-12-27 | 2012-07-05 | Medtronic, Inc. | Application limitations for a medical communication module and host device |
US20130197607A1 (en) | 2011-06-28 | 2013-08-01 | Greatbatch Ltd. | Dual patient controllers |
US8954148B2 (en) | 2011-06-28 | 2015-02-10 | Greatbatch, Ltd. | Key fob controller for an implantable neurostimulator |
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US20130085550A1 (en) * | 2011-09-30 | 2013-04-04 | Greatbatch, Ltd. | Medical implant range extension bridge apparatus and method |
US20130332201A1 (en) * | 2012-06-12 | 2013-12-12 | Peter L. Hagelstein | Data acquisition apparatus configured to acquire data for insurance purposes, and related systems and methods |
US20140025401A1 (en) * | 2012-07-17 | 2014-01-23 | Peter L. Hagelstein | Data acquisition apparatus configured to acquire data for insurance purposes, and related systems and methods |
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2004
- 2004-11-19 US US10/993,699 patent/US7460912B2/en not_active Expired - Fee Related
-
2005
- 2005-10-14 EP EP05809800.5A patent/EP1833564B1/en not_active Not-in-force
- 2005-10-14 WO PCT/US2005/036811 patent/WO2006055131A1/en active Application Filing
- 2005-10-14 JP JP2007543049A patent/JP4940147B2/en active Active
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2008
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Also Published As
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US7460912B2 (en) | 2008-12-02 |
WO2006055131A8 (en) | 2007-07-26 |
JP4940147B2 (en) | 2012-05-30 |
JP2008520342A (en) | 2008-06-19 |
EP1833564A1 (en) | 2007-09-19 |
WO2006055131A1 (en) | 2006-05-26 |
US20090076570A1 (en) | 2009-03-19 |
US8718772B2 (en) | 2014-05-06 |
US20060111759A1 (en) | 2006-05-25 |
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